<p> There is little research into the effect religion may have on the gender assignment of intersex persons. This research addresses that issue, exploring the possible roots of contemporary gender assignment practices in ancient notions of purity and pollution, or purity rules, and argues that such customs or norms influence contemporary perspectives and attitudes surrounding gender identity. This work examines the practice of gender assignment of intersex persons in the &ldquo;Western&rdquo; world, along with any and all associated medical procedures and the teaching of gender performance and the adoption of gender performance by the subjects, and suggests that the practice of gender assignment is, in fact, a ritual practice stemming from western notions of purity and pollution surrounding the body, specifically, gender as it relates to the body. Finally, this work concludes that the &ldquo;Western&rdquo; notion of purity and pollution which frame the ritual practice of gender assignment, have failed to evolve despite advances in science, psychology and social ethics and thus, this ritual practice needs to be seriously reexamined.</p>

M.A. (Philosophy) / Please refer to full text to view abstract

A thesis submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg in fulfillment of the requirements for the degree of Doctor of Philosophy December 2015 / Introduction South Africa is characterised by numerous dichotomies and diversities, within which its two-tier healthcare system operates. An under-resourced state sector serves a majority of the population and a resource-intensive private sector serves a small minority. Within the constitutional framework of human rights and distributive justice there are nevertheless expectations of fair and equal access to healthcare services. There is furthermore an expectation of quality care across the health system, in spite of a number of systemic challenges related to staff and equipment shortages, unrealistic working hours and poor working conditions. Organ transplant is available to different degrees within the South African healthcare sector. Whilst transplant programmes are burgeoning internationally, cadaver transplant numbers in South Africa have decreased over recent years as donor organs have become increasingly scarce. Current research suggests that these challenges to transplant in South Africa arise from aspects of personal and cultural beliefs, illegal transplant practices and resource constraints - which all serve to compromise the ethical implementation of transplant services in the two-tier healthcare system. The impact of interprofessional communication and transplant professional–patient communication has not been previously researched in South Africa. However, research into other healthcare issues has shown that communication is vital to the ethical provision of healthcare services, especially those which involve patient-centeredness and multidisciplinary interaction. Transplant involves a significant amount of communication within a particularly large network of recipients and their families, cadaver donor families, living donors and a range of transplant professionals. This communication seems a vital part of the transplant process, disseminating information which role-players need in order to promote favourable outcomes. Given the extensive networks involved in the transplant process, communication would seem to be a fertile area for research. This study aimed to explore communication in organ transplant in Gauteng province, South Africa. It considered both interprofessional communication and communication with patients as this took place within the hierarchical healthcare system and throughout the transplant process. An ethics of care framework was utilised in order to account for the expectations of care which South Africans confer upon their health system. Methods The study took place in the Gauteng province of South Africa across six healthcare institutions. Both the state and the private sector were equally represented. Altogether, thirty in-depth interviews with transplant professionals, two focus groups with transplant coordinators, two interviews with cadaver donor families, and one focus group with living kidney donors, were conducted. Thematic analysis and triangulation of the data utilising Braun and Clarke’s (2006) principles revealed three main themes relating to context, communication with patients, and interprofessional communication Findings The South African transplant context is complex and multifaceted, shaped by both the patients’ expectations of care and the transplant professionals’ perceptions of care. These expectations and perceptions are influenced by personal beliefs, suspicions of biomedicine, the media, and resource inequalities which pose challenges to accessing transplant services. The transplant context is characterised by ethical dilemmas relating to distributive justice, as questions about resource distribution and allocation of donor organs are raised. Transplant communication is influenced by context and varies depending upon role-players in transplant and the different phases of transplant. Demands for care by those hoping to receive an organ had a noticeable influence on transplant professional-potential recipient communication in the pre-transplant phase, a period when emotions of desperation and uncertainty were prominent. By the time recipients had received their organ and entered the more stable post-transplant phase, a relationship of trust developed in which communication was regular and caring roles seemed fulfilled. The opposite trend was evident in communication between transplant professionals and donor families. This was characterised by notions of care in the pre-transplant phase, contrasting with a perception amongst donor families that care was sometimes overlooked in the post-transplant phase - a time often imbued with chronic uncertainty. Even in the pre-transplant phase numerous ethical issues surrounding autonomy, decision-making and informed consent proved to complicate and challenge transplant communication. Interprofessional communication was shaped by hierarchical institutional organisation, a lack of continuity of care, and resource constraints, all of which challenged transplant professionals seeking to provide care, and sometimes resulted in aggressive interchanges. The pressure to procure an organ timeously – which could result in patient care and professional respect being somewhat disregarded – could so compromise interprofessional communications that moral distress was created. Furthermore, as a result of miscommunications, an ethical vacuum where the best interests of patients in the transplant process were not, apparently, a foremost consideration, was identified. Conclusion Transplant is a highly complex process requiring a number of different communication styles and skills and accompanied by intricate ethical challenges. Although transplant professionals seemed cognisant of the need for careful communication, inequalities, resource scarcity and conflict intervened to create a space for moral distress and uncertainty in which communication was affected, and the provision of care was the casualty. Appraising results within an ethics of care framework suggests that transplant in Gauteng cannot be considered to be a process fully informed by the imperative of care. The ethics of care proved to be a helpful framework for understanding transplant communication in Gauteng because of the way it accounts for interpersonal relationships - fundamental to the transplant process - whilst also emphasising the importance of resources necessary to provide good care. It was concluded that in the current environment, where there is little legal direction or political buy-in, transplant in Gauteng will be unable to reach its full potential. / MT2016

This thesis investigates the moral content of illness ontologies in different healing systems, in particular biomedicine and homeopathy. It was motivated by the wish to gain a greater understanding of the possible meaning and ethical significance underlying the increasing popularity of complementary and alternative medicine (CAM) in Western countries. CAM is an umbrella term for a diverse group of therapeutic approaches, indicating their marginalized status in relation to conventional, scientific medicine. However, despite their diversity most CAM share a common bond by subscribing to a holistic perspective on life, health and illness. It is for this reason that this thesis concentrates on the conceptual level. The subject is approached by making use of interview material from five homeopathic doctors from Austria. Their perspective on different aspects of non-conventional, as well as biomedical, practice and underlying theory provides the springboard for theoretical investigations. The demand for scientific evidence of CAM is critically examined. The issue of increasing pluralism in health care is explored, along with its challenge of finding appropriate epistemological approaches for therapeutic systems that are based on different illness ontologies. The favored approach in this thesis is based on the recognition by medical historians that there are four basic illness axioms: "illness as loss of balance", "illness as disruption of interpersonal communication", "illness as a physical defect" and "illness as pathic creation". These axioms are matched respectively with four different epistemic pathways: the dialectical, the hermeneutical, the analytical and the phenomenological. The interviewees considered the more humane quality of the doctor/patient relationship in their homeopathic practices to be due to the holistic premises of homeopathy, which place the subjective dimension of patients at their center. The difficulty of achieving informed consent in the commonly used sense in homeopathic practice was solved by engaging in a shared decision-making process. Life was explained by the interviewees in vitalistic terms. Although rejected by science, the notion of vitalism appears to hold significance for the public. Illness was always perceived as a multidimensional process and not as a purely physico-chemical dysfunction. It became evident that the holistic perspective takes account of the many dimensions of human illness, of which neither the conventional reductionist conception nor the dualistic mind/body approach are capable. However, the unmanageable complexity of holism poses a problem for therapeutic practice. A conceptual approach providing some structure for the holistic multidimensionality is found in the four illness axioms and in analogous observations by Aristotle. It is concluded that there could be a connection between the increased popularity of CAM and their underlying holistic perspective, since this theoretical foundation allows the practitioner to address the patient in a whole-person way. At the same time the holistic perspective provides a much broader scope than biomedicine for patients to influence their health. The recognition that human multidimensionality needs to be appreciated at the level of illness ontology may also provide an impetus for bioethics to approach contemporary ethical challenges from a perspective of an ethics of the good life, instead of concerning itself predominantly with setting limits in the arena of technological medicine.

<p>Respect for autonomy is the foundation of modern bioethics, even (or especially) where bioethics is attentive to the problem of suffering caused by the practice of medicine itself. It provides guidance in the midst of therapeutic and moral uncertainty, justification for morally problematic enterprises, and the promise of protection against self-serving or predatory medical personnel. Yet bioethical arguments that appeal to the injustice or the horror of suffering depend on an instinctual and uncomplicated association of suffering, especially imposed suffering, with evil. This uncomplicated association, this flattening of the complexities of the moral landscape, must lead to a diminished capacity to navigate the very difficulties that define the field of bioethics. This dissertation explores the relationship, particularly, of autonomy, suffering, and happiness in modern bioethics, as represented by three key theorists (James Childress, Tom Beauchamp, and H. Tristram Engelhardt). It then contrasts these findings with resources from the Christian tradition: Luke-Acts, the letters of Paul, and the theologians Thomas Aquinas, Catherine of Genoa, and Margaret Ebner. Their accounts of the meaning and experience of suffering within well-lived lives makes for a more robust account of the moral life, one in which suffering plays a formative part.</p> / Dissertation

Thesis (M.A.)--York University, 1997. Graduate Programme in Philosophy. / Typescript. Includes bibliographical references (leaves 101-109). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ27378.

Thesis (Ed.D.) - Simon Fraser University, 2005. / Theses (Faculty of Education) / Simon Fraser University. Includes bibliographical references leaves 322-244. Also issued in digital format and available on the World Wide Web.

Thesis (M.A.)--Trinity International University, 2001. / Abstract. Includes bibliographical references (leaves 107-122).

Thesis (Ph. D.)--York University, 2001. Graduate Programme in Philosophy. / Typescript. Includes bibliographical references (leaves 365-382). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNQ66368.

<p> I consider the claims made by medical ethicists that funding by pharmaceutical companies threaten the integrity of medical research and the claims of philosophers of science that evidence-based medicine can provide a sound epistemic foundation on which to base medical treatment decisions. Drawing on both game theory and medical history, I argue that both medical ethicists and philosophers of science have missed crucial aspects of medical research. I show that both veritistic and commercial aims are enduring and entrenched aspects of medical research. Because these two drives are perpetually pulling medical research in different directions, I identify the resultant conflict as the fundamental antagonism </p><p> The primary task of the dissertation is to provide a framework that incorporates both drivers of medical research. Specifically, I argue that medical research is best conceived of as an asymmetric arms race. Such a dynamic is typified by a series of moves and countermoves between competing parties who are adjusting to one another's behavior, in this case between those who seek to make medical practice more responsive to good evidence and those whose primary motivations are instead commercial in character. </p><p> Such a model presents three challenges to standard evidential hierarchies which equate epistemic reliability with methodological rigor. The first is to show that reliability and rigor can (and do) come apart as a result of the countermeasures employed by manufactures. This fact suggests that in considering policy proposals to improve epistemic reliability, it is robustness (i.e. resistance to manipulation) that should be the crucial desideratum. The second consequence is a reorientation of medical epistemology. One of the primary strategies that manufacturers have employed is to manipulate the dissemination of information. A focus on an isolated knower obscures the impact that industry has in shaping what information is available. To address these problems medical knowledge must be understood from a social epistemological framework. Finally, and most importantly, the arms race account suggests that the goal of identifying the perfect experimental design or inference pattern is chimerical. There is no final resolution to the fundamental antagonism between commercial and scientific forces. There is only a next move.</p>